One of our most frequently asked questions is, “Will my insurance cover Prescribe FIT?” The good news is that Prescribe FIT is covered by insurance through Medicare, Medicaid, and most commercial insurance carriers. In fact, 94% of insurance claims submitted for Prescribe FIT are accepted.
Keep in mind that, while insurance typically accepts our program, you may still have a minimal out-of-pocket cost. We’ll explore the reasons for this below, but remember, this is an investment in your health and quality of life. Many of our patients without insurance even opt to self-pay for this reason.
In this article, we cover the basics of Medicare, Medicaid, and private insurance coverage of Prescribe FIT. When you’re ready to get started, our team will confirm your benefits eligibility and financial responsibility for the program prior to your enrollment.
Medicare Coverage of Prescribe FIT
Medicare covers Prescribe FIT in most instances as a Specialist Office Visit. However, you may have out-of-pocket costs associated with the program depending on the specifics of your Medicare coverage.
Patients with Original Medicare will have a monthly coinsurance of 20% of the cost of Prescribe FIT after meeting their annual deductible.
- The typical cost of this coinsurance is around $50 in the first month and $40 per month after for most patients. This amount may be more or less depending on your coverage.
- Medigap or Supplemental Medicare plans typically help cover the cost of coinsurance for Prescribe FIT. The amount that your plan will cover is specified by your Medigap insurance provider.
Medicare Advantage covers the cost of Prescribe FIT with a required copay.
- The cost of your copay can be found on your Medicare Advantage member ID card under Specialist Office Visit. It is typically listed under “Specialist,” “Spec,” or “SP.” It is usually no more than $40 per month.
If you have further questions about your Medicare coverage, you can call the dedicated Medicare help line at 1-800-MEDICARE (1-800-633-4227) or visit https://www.medicare.gov/what-medicare-covers.
Medicaid Coverage of Prescribe FIT
Prescribe FIT is typically covered by Medicaid with no out-of-pocket costs to the patient. However, unlike Medicare, Medicaid is managed on a state-by-state basis. You may be responsible for copayments, coinsurance, deductibles, or other charges depending on the state you live in.
For questions and other information related to your Medicaid coverage, you can visit https://www.benefits.gov/ for more details about your state’s Medicaid benefits.
Private Insurance Coverage of Prescribe FIT
You may have private insurance, such as through your employer or through the Insurance Marketplace. In this case, your coverage and out-of-pocket costs for Prescribe FIT will vary depending on the details of your policy. We can help you determine eligibility.
How and when will I be billed?
In most cases, your orthopedic physician will submit a claim to your insurance on your behalf. If you have any out-of-pocket costs, the practice will bill you directly.
Patients with out-of-pocket costs for Prescribe FIT will typically be billed on a monthly basis. While you may have out-of-pocket costs for Prescribe FIT, it’s important to keep in mind that this cost is an investment in your long-term health.
In addition, if you prioritize your wellbeing now with a smaller, more manageable investment, you can end up saving on much greater costs from more serious health conditions in the future.
If you’re ready to get started, the Prescribe FIT team will confirm your coverage details prior to your enrollment. Contact us today at https://www.prescribefit.com/enroll/.
Published on February 24, 2023
